1336180314 NPI number — DR. MARK A THIMINEUR MD

Table of content: DR. MARK A THIMINEUR MD (NPI 1336180314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336180314 NPI number — DR. MARK A THIMINEUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIMINEUR
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336180314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 DIVISION ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-1570
Provider Business Mailing Address Fax Number:
203-732-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 DIVISION ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-732-1570
Provider Business Practice Location Address Fax Number:
203-732-1576
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  033132 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 033132 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3149086006 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001331321 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4569760 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTH CONNECTICUT P . This is a "223514271" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223514271 . This is a "HMC/PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223514271 . This is a "MASHANTUCKET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V0370 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033132CT02 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223514271 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223514271 . This is a "CHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 764977 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00133132101 . This is a "BLUECARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A752119 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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